台灣老年人憂鬱之軌跡分析

前言：台灣老人憂鬱症盛行率為16%~25%，重鬱症盛行率在0.3%~13%之間，老人憂鬱成因及其對健康影響之探討相形重要。本研究探討不同憂鬱軌跡之人口學、生活習慣、疾病及健康之特性，及不同憂鬱軌跡對後續失能之影響。材料方法：以國民健康署「台灣中年身心社會狀況長期追蹤調查」，1996、1999、2003、2007年四波資料進行軌跡分析及探討。結果：憂鬱軌跡區分為六大型態，「持續維持無憂鬱症狀」、「持續維持低度憂鬱症狀」、「憂鬱症狀浮動於邊際」、「憂鬱症狀維持不佳，持續上升」、「憂鬱症狀控制良好，持續下降」、以及「憂鬱症狀控制不佳，緩慢上升」。相較於「持續維持無憂鬱症狀」者，女性較高風險處於「持續維持低度憂鬱症狀」、「憂鬱症狀浮動於邊際」、「憂鬱症狀維持不佳，持續上升」、「憂鬱症狀控制良好，持續下降」及「憂鬱症狀控制不佳，緩慢上升」，其Odds Ratio(OR)分別為1.59、3.50、1.93、4.45及4.02；自覺健康狀況顯著與憂鬱軌跡有關，分別為「持續維持低度憂鬱症狀」(OR=1.00)、「持續維持低度憂鬱症狀(OR=2.34)、「憂鬱症狀浮動於邊際」(OR=4.56)、「憂鬱症狀維持不佳，持續上升」(OR=4.49)、「憂鬱症狀控制良好，持續下降」(OR=4.65)、以及「憂鬱症狀控制不佳，緩慢上升」(OR=9.58)。對後續IADL與ADL之影響，「憂鬱症狀維持不佳，持續上升」、「憂鬱症狀控制不佳，緩慢上升」者，其IADL與ADL顯著較差。結論：憂鬱軌跡型態，呈現六種不同之動態變化過程。女性憂鬱軌跡較男性為差，且自覺健康狀況與較差之憂鬱軌跡顯著相關；憂鬱軌跡對於後續IADL、ADL失能具預測力。

Objectives: In Taiwan, the prevalence of elderly depression is 16% to 25%, and major depressive disorder prevalence is 0.3% to 13%. Elderly depression is an important issue which worthy of in-depth investigation. This longitudinal study aims at the relationships between depression trajectory and the potential risk factors, including demographic characteristics, lifestyles, health status; and the IADL or ADL consequences of different depression trajectories. Methods: Four-wave (1996, 1999, 2003, 2007) longitudinal data from “The Survey of Health and Living Status of the Near Elderly and Elderly in Taiwan” were included for depression trajectory analysis.Results: Six depression trajectories are identified: “No depressive symptom”, ”Few depressive symptoms”, ”Depressive symptoms are marginally floating”, ”Poor maintenance with rising depressive symptoms”, ”Controlled depressive symptoms”, ”Poor-controlled with rising depressive symptoms”.Compare these depression trajectories, “No depressive symptom” as reference group, women are at higher risk in ”Few depressive symptoms”, ”Depressive symptoms are marginally floating”, ”Poor maintenance with rising depressive symptoms”, ”Controlled depressive symptoms”, and ”Poor-controlled with rising depressive symptoms”, the ORs are 1.59, 3.50, 1.93, 4.45, 4.02, respectively. Poor self-rated health are significantly correlated to depression trajectories, the ORs for each depression trajectory groups are, “No depressive symptom, OR=1.00”, ”Few depressive symptoms, OR=2.34”, ”Depressive symptoms are marginally floating, OR=4.56”, ”Poor maintenance with rising depressive symptoms, OR=4.49”, ”Controlled depressive symptoms, OR=4.65”, and ”Poor-controlled with rising depressive symptoms, OR=9.58”. In addition, the IADL or ADL consequences in 2007, are significantly poor in two depression trajectory groups, ”Poor maintenance with rising depressive symptoms” and ”Poor-controlled with rising depressive symptoms”.Conclusion: Six depression trajectories are identified. Women are at high risk with poor depression trajectories than men, and poor self-rated heath are significantly associated with depression trajectories. Depression trajectories should predict IADL or ADL consequences.